A comparison of laparoscopic and open adrenalectomy in patients with pheochromocytoma

Purpose: While safety and efficacy of laparoscopic adrenalectomy are relatively well documented, this procedure remains challenging for pheochromocytoma. The purpose of our investigation was to assess the perioperative profiles of laparoscopic adrenalectomy (LA) with those of open adrenalectomy (OA) in patients with pheochromocytoma. Materials and Methods: Between January 1997 and October 2005, 31 patients with pheochromocytoma underwent surgical removal, including 15 LA and 16 OA. The LA was performed via a lateral decubitus transperitoneal approach. The mean tumor size was similar in both groups (LA 6.0cm vs. OA 5.7cm). All patients underwent extensive preoperative medical preparation with alpha-blockers. The intraoperative hemodynamic instabilities and perioperative profiles were retrospectively analyzed. Results: No conversion to open surgery was required with either procedure and no mortality was observed. Hypertensive crisis (systolic blood pressure> 200mmHg) and severe tachycardia (heart rate> 100/min) were more common in the OA group (LA 13.3 and 26.7% vs. OA 56.3 and 62.5%). The mean operating times for both groups were similar (LA 182.0 ±47.0 min vs. OA 183.1±66.5 min), but the duration of hospitalization was shorter in the LA group (LA 5.3 ± 2.2 days vs. OA 6.8 ± 1.0 days). The estimated blood loss was greater in the OA group (LA 103.3 ± 44.2ml vs. OA 159.4 ± 66.8ml). Intravenous morphine was needed in 56.3 % of the OA, but in only 13.3% of the LA group. There were no significant differences in the postoperative complications between the two groups. Conclusions: The laparoscopic resection of pheochromocytomas can be accomplished safely and effectively. A short hospital stay, with minimal perioperative morbidity and the eradication of endocrinopathy, support the minimally invasive approach for adrenalectomy in patients with pheochromocytoma.